Depression, fatigue, fever and other flu-like symptoms are commonly reported
adverse side effects of treatment with both standard and pegylated interferon.
However, there are also occasional reports of (generally) reversible opthalmopathy
(eye complications) among patients with hepatitis C treated with pegylated
interferon, according to data presented at the 37th EASL in Madrid, Spain
this week.
There is little experience with eye disease in the context of treatment
with interferon for hepatitis C. The frequency and clinical relevance
of opthalmopathy is not yet established, according to the study authors.

The current study was conducted at the Deutscher Klinik fuer Diagnostik
in Wiesbaden, Germany. Researchers evaluated 26 patients with hepatitis
C opthalmologically before, during and after treatment with PEG-Intron
(peginterferon alfa-2b).

The investigators defined peginterferon-induced opthalmopathy if a patient
experienced any one of the following conditions: reduction in the visual
field, retinitis, unsharpness of the papilla, or cotton-wool focuses.

Study Results

Ophthalmological data were available in 19 patients. In 5/19 (26%) patients
at least one of the conditions were found. Only one reported significant
symptoms, i.e. reduction in visual field. In another, treatment was discontinued
after six weeks because the risk of a serious complication was judged
to be high due to a one-sided anophthalmus. Diabetes mellitus was also
present in this patient.

Retinitis and cotton-wool focuses disappeared after treatment had been
stopped, and viral eradication was obtained after only six weeks of treatment
(4 months after end of therapy). In all other patients, therapy was continued;
ophthalmological changes reversed when treatment was stopped.

The researchers conclude that the incidence of ophthalmopathy due to
treatment with pegylated interferon "may be underestimated."
It appears to be reversible in most cases and without clinical relevance.
Still, in some patients it may impact the course of therapy. "Ophthalmological
observation is recommended in patients treated with pegylated interferon."

Editor's Note: Mitchell Shiffman, MD, made the following remarks
on eye complications in hepatitis C patients treated with interferon in
response to a question from the wife of a man who has lost complete vision
following treatment with PEG-Intron/ribavirin:

"This is an absolute contraindication to proceed with interferon
therapy and I am glad that the treatment has been stopped. This should
have occurred as soon as he noted visual changes. Hopefully he remains
in sustained virologic response. If he does relapse he should NOT
be retreated with interferon ever again in the future. With regards to
the prognosis of his vision, your ophthalmologist could better advise
you as to the likelihood that vision will return to that eye.

Retinal and visual changes are well-described complications [sometimes]
associated with interferon therapy. Fortunately, they do not occur very
often. However, when they do occur they can be severe, debilitating and
irreversible." (From HIV and Hepatitis.com. The
Doctor Is In. Hepatitis C section).